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Table 2 Barriers to the implementation of preemptive pharmacogenetic-guided chemotherapy dosing

From: Preemptive pharmacogenetic testing to guide chemotherapy dosing in patients with gastrointestinal malignancies: a qualitative study of barriers to implementation

CFIR Domain CFIR Construct Theme Representative Quotation
Intervention characteristics Evidence strength and quality Limited evidence base For therapeutic dose recommendations, I want it to be from NCCN, ASCO, or the Europeans … Anything less than that is weak. (O9)
I have no problems with palliative intent … but when we talk about curative, unless we had prospective data, I’d be a little more cautious. (O15)
Relative Advantage Questionable impact on clinical care How often is this really going to change our therapy? ...If we don’t change it, is it a matter of life or death, or is it slight toxicity that we can manage otherwise? (P3)
Complexity Cumbersome and lengthy testing process If you don’t make it … as easy as a CBC … you may get a start, but somewhere down the road, it will fall off the track. (O12)
I don’t – I can’t – do preemptive [PGx testing] because usually when they’re coming to see me, they need to start therapy sometime in the next couple of weeks, and so I’m not going to have a result back to actually do a meaningful assessment. (O1)
Outer Setting Patient Needs & Resources Lack of alternative therapeutic optionsa If you don’t have 5-FU for a colon cancer patient, you really are very limited in terms of what you have in your treatment armamentarium, especially if they have a curable disease … (O3)
External Policies & Incentives Lack of insurance coverage I would certainly want to know what, if any, cost or coinsurance was passed down to the patient … I’d be a little bit worried if it turned out that only people with certain types of insurance would be eligible for the testing. (O8)
Inner Setting Access to Knowledge & Information Challenging PGx test interpretation Once I had the information, UGT1A1, for instance, I wouldn’t know what to comfortably do with it. (O7)
If you’re in a non-academic center and you don’t have other people with expertise in a multidisciplinary fashion, then you’re sort of stuck with a test that you’re not sure what to do with. (O14)
Characteristics of Individuals Knowledge & Beliefs About the Intervention Clinician lack of knowledge I honestly perceive just a baseline deficiency in my own education around DPYD. (P7)
Self-efficacy Remembering to order PGx testing for eligible patients The prescriber remembering to do it … is always the worst. (P2)
  1. a Reported by medical oncologists but not oncology pharmacists
  2. Abbreviations: CFIR Consolidated Framework for Implementation Research, O Medical oncologist, NCCN National Comprehensive Cancer Network, ASCO American Society of Clinical Oncology, P Oncology pharmacist, PGx Pharmacogenetic, 5-FU 5-fluorouracil